(ippe)...during ippe rotations, the students have an excellent opportunity to develop an array of...

LECOM School of Pharmacy

Bradenton, FL Campus

Introductory Pharmacy Practice Experiences

(IPPE)

Class of 2014

2011

Experiential Education Program Manual

TABLE OF CONTENTS

WELCOME LETTER 4

EXPECTATIONS 5 Student 5

Preceptor 6

ROTATION SCHEDULE 7

LEARNING OBJECTIVES 8

LECOM SCHOOL OF PHARMACY PROGRAM OUTCOMES 9

School of Pharmacy Outcomes 9

IPPE Outcomes 10

SUCCESS COMPETENCIES 12

ROTATION POLICIES AND REGULATIONS 14 Pre-requisites 14

Attendance Policy 15

Professional Liability Insurance 16

Site Selection 16

Rotation Binder/Portfolio 16

Evaluations 17

Grading 17

Weather Conditions 18

Dismissal from Sites 18

Academic Honesty & Plagiarism 18

Professionalism 19

Dress Code 19

Confidentiality & HIPAA 19

Verification of Site and Preceptor Information in PharmAcademic 20

IPPE ROTATION DESCRIPTIONS 21 Institution IPPE Rotation 22

Community IPPE Rotation 25

ROTATION ASSIGNMENTS 28 General Guidance for a Quality Assignment 28

Assignment I – Rotation Site Description 29

Institution Site Data Collection Worksheet 30

Community Site Data Collection Worksheet 34

Assignment II – Reflection Paper 37

Assignment II – Drug Information Question Worksheet 39

Drug Information Question Processing (Modified Systematic Approach) 40

TABLE OF CONTENTS, Continued

Assignment IV – Medication History/Patient Interview Worksheet-Instructions 43

Medication History/Patient Interview Worksheet 44

Assignment V – OTC Formulary/Related Products Reference 46

Assignment VI – Soap Note/Patient Self-Medication Consultation Worksheet 47

Soap Note 48

Soap Notes Guide 49

COMPLETING EVALUATIONS (ASSESSMENTS) 50 IPPE Midpoint Assessment of Student by Preceptor 52

Midpoint Deficiency Notification 55

IPPE Sample Student Self-Assessment 56

IPPE Final Assessment of Student by Preceptor 59

Student Assessment of Site and Preceptor 63

PHARMACADEMIC USER INFORMATION 66 General Instructions for using PharmAcademic 67

Log in/Change Password 67

Preceptor Instructions 68

View Current Schedule 68

Entering Availability for FUTURE matches for LECOM School of Pharmacy 68

Completing a Student Evaluation 70

Viewing Completed Evaluations 72

Student Instructions 74

Assessments 74

Viewing Completed Evaluations 76

SITE-SPECIFIC REQUIREMENTS 78 CERTIPHI Instructions 79

Background Check 80

Drug Screen 82

MVR (Motor Vehicle Report – Driving History) 84

FIELDPRINT Instructions 84

Fingerprint for Florida rotation site 84

Fingerprinting for other states 85

Other screening instructions 85

RESOURCES 87 Contact Information 88

Experiential Checklist 89

Student Site Contact Form 90

Absence Request Form 91

Welcome to Introductory Pharmacy Practice Experiences (IPPEs)

Dear Students and Preceptors,

Congratulations to our students for reaching an important milestone and thanks to our preceptors

for mentoring our students to reach higher professional goals. The purpose of Introductory

Pharmacy Practice Experiences (IPPE) is to apply the facts, information, and concepts gained in

the first-year didactic coursework in “real-life” situations. The IPPE rotations do not emphasize

the need to gain knowledge of abstract theories, but rather use an integrative approach to learning

that includes experience and interactions between the students and preceptors in various health

care settings to turn didactic knowledge into practical knowledge.

During IPPE rotations, the students have an excellent opportunity to develop an array of skills

such as professionalism, communication, problem solving, critical thinking, and professional

competence. We encourage our preceptors to emphasize to the students the importance of

connecting knowledge, critical thinking skills, and action.

The goal of these experiences is for our students to initiate proficiency in the operations of

community and institutional practices. This includes providing safe and effective

pharmacotherapy plans and optimizing patients’ outcomes by assuring safe and accurate

preparation and dispensing of medications, providing reliable health care information, and

promoting public health.

We encourage the preceptors and students to use this manual and provide input to continuously

improve the quality of experiential rotations. We look forward to your feedback and will do our

best to support you during the rotations.

On behalf of the administration and faculty of LECOM School of Pharmacy, we wish you a

successful rotation experience!

Laura L. Stevenson, PharmD, MS

Director of Experiential Education

Associate Professor of Pharmacy Practice


5000 Lakewood Ranch Boulevard

Bradenton, Florida 34211

Phone 941.782.5677

Fax 941.782.5733

[email protected] or [email protected]

mailto:[email protected]


LECOM EXPECTATIONS for our STUDENTS

The student is responsible for ensuring successful completion of the rotation by emphasizing the

following:

1. Review and comply with the information outlined in this manual and the rotation

syllabus.

2. Have applicable Pharmacist Intern License(s) available at all times for review by site,

preceptor, or Office of Experiential Education.

3. Fulfill all prerequisites specific to the rotation including immunizations, background

checks, drug screenings, HIPAA/OSHA training, and anything additional as required by

site.

4. Follow all laws and regulations that govern the pharmacy profession.

5. Fully engage in the experience provided by the preceptor and the rotation site.

6. Recognize and appreciate that the preceptor is volunteering their time, energy and

expertise to help you develop and improve your professional skills.

7. Work independently, but seek advice and accept direction from the preceptor.

8. Learn to say “I don’t know” and follow through with acquiring the necessary knowledge

to answer a question or complete a task.

9. Submit all assignments and evaluations in a timely fashion. .

10. Positively accept feedback and constructive criticism. Recognize its intended purpose

(helping the student grow professionally).

11. Exhibit professional conduct at all times.

PRECEPTOR CHARACTERISTICS AND EXPECTATIONS

The following characteristics have been outlined by the Accreditation Council for Pharmacy

Education (ACPE) Accreditation Standards and Guidelines:

1. Practice ethically and with compassion for patients.

2. Accept personal responsibility for patient outcomes.

3. Have professional training, experience, and competence commensurate with their

position.

4. Utilize clinical and scientific publications in clinical care decision making and evidence-

based practice.

5. Have a desire to educate others (patients, care givers, other health care professionals,

students, pharmacy residents).

6. Have an aptitude to facilitate learning.

7. Be able to document and assess student performance.

8. Have a systematic, self-directed approach to their own continuing professional

development.

9. Collaborate with other health care professionals as a member of a team.

10. Be committed to their organization, professional societies, and the community.

11. Maintain their professional licensure and precepting license, if applicable.

The preceptor will be responsible for the following:

1. Listening to preceptor training via The Pharmacist’s Letter Preceptor Resource and

Training Network regarding General Policies and Procedures and IPPE as indicated by

School.

2. Review and employ the material contained in this manual and the rotation syllabus.

3. Serve as a role model for professional practice.

4. Interact with the student as teacher-student versus employer-employee.

5. Determine the student’s level of competence and provide a learning environment and

opportunities for the student to develop and improve professional skills.

6. Provide timely constructive feedback to the student in a private and confidential manner.

7. Inform students of any areas needing improvement as early as possible.

8. Review to ensure that assignments are complete. Complete midpoint and final

evaluations, review them with the student, and submit to the Office of Experiential

Education as outlined in this manual.

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IPPE Rotation Schedule

First rotation block: 7/25/11 – 8/19/11

Second rotation block: 8/29/11 – 9/23/11

LECOM observes the following holiday calendar; however the preceptor/site may require

students to be in attendance on these days if they fall within a rotation block. Students must

coordinate attendance with their preceptor to be off during these holidays. The attendance policy

applies to holidays.

New Year’s Day

Freedom Day (Martin Luther King Jr. Day)

Memorial Day

Independence Day

Labor Day

Thanksgiving Day and the day after

Christmas Day

Learning Objectives

Share these objectives with your preceptor prior to the start of your rotation, or on the first day

while reviewing the manual. These objectives should serve as general guidelines throughout the

rotation. However, your preceptors will have the opportunities to add additional tasks specific to

the site in order to provide you with more practice experiences.

The goal of these rotations is to have the students become proficient in the daily practice of

pharmacy operations. The student will:

1. Describe the structure, the organization, and chain of command within the organization.

2. Describe the roles and responsibilities of the diverse personnel working in the pharmacy.

3. Become familiar with the workflow in the pharmacy.

4. Handle the processing of prescriptions or physician’s orders from their initial receipt in

the pharmacy to the dispensing of the product to the patient or to the patient’s

floor/bedside.

5. Gain experience handling parenteral medications as well as other types of formulations.

6. Document and/or file orders or other documents pertaining to the daily work in the

pharmacy.

7. Use pharmacy technology pertaining to the site and understand the technologies’ impact

on the practice of pharmacy.

8. Communicate efficiently with patients (if appropriate) and members of the health care

team.

9. Be professional at all times.

This list is not intended to be exhaustive. The preceptor has the authority to adapt and to add

other experiences that he/she feels the student will benefit from.

LECOM School of Pharmacy Program Outcomes

The following are the curricular outcomes that are expected to be met after successfully completing the

Pharmacy program. Graduates of the LECOM School of Pharmacy will be:

A. Responsible care givers who are advocates for health improvement and are accountable for

positive patient outcomes. This includes goals related to both treatment and prevention.

B. Leaders who endeavor to advance the profession of pharmacy by serving as role models in the

health care community. This includes supervision of other employees, activity in professional

organizations, teaching and/or precepting, working on multidisciplinary teams and setting up

collaborative practice agreements.

C. Professionals who strive for continuous growth and improvement of personal attitudes, skills,

and knowledge. Examples include a commitment to lifelong learning, integrity, communication

skills, respect for others, ethics, and reliability.

D. Team members who promote open communication to create and maintain a dynamic

relationship with patients and interdisciplinary colleagues. Important skills for achieving this

outcome include diplomacy, empathy, and cultural competence.

E. Medication managers who design, implement, monitor, evaluate, and modify evidence-based

pharmaceutical care plans based on a patient’s specific needs. Achieving this outcome will require

health literacy and consideration of individual patients’ specific needs related to cultural,

behavioral, or social factors.

F. Practitioners who retrieve, analyze, and interpret professional, lay, and scientific literature, and

apply the information in both patient-centered and population-based care.

G. Experts who utilize medication knowledge effectively, for example, interpreting and

communicating the package insert to physicians, patients and other healthcare providers. This

requires mastery of the pharmaceutical sciences.

H. Pharmacists who promote and ensure the safe, efficient and appropriate dispensing and delivery

of medications. This involves acquisition of knowledge on medications, pharmacy operations,

legal aspects of pharmacy practice, and the use of technology.

IPPE Outcomes†

Professional Outcomes

1. Provide Pharmaceutical Care

a. Be an advocate for the patient centered model of practice at each site

b. Apply critical thinking skills to all aspects of daily practice

c. With the help of the preceptor, identify, resolve and prevent drug related problems

d. Communicate with other healthcare professionals to resolve and prevent drug

related problems

e. Document interventions in a format appropriate for the practice setting

f. Display the attitudes, habits and values required to render pharmaceutical care.

i. Provide pharmaceutical care ethically and compassionately.

ii. Provide pharmaceutical care in a professional manner.

g. Collect and interpret data related to drug therapy from patients and/or caregivers

h. Communicate with patients to educate and help meet drug-related needs

2. Manage Medication Distribution and Control Systems

a. Dispense and/or compound medications with complete accuracy, including

necessary calculations and follow aseptic techniques

b. Gain continual proficiency in medication name recognition and indications

c. Apply guidelines for safe and controlled storage of medications (quality control)

including in the pharmacy and patient education for storage at home

d. Understand the system for purchasing drugs, DME (durable medical equipment)

and supplies.

e. Explain the inventory control system

f. Understand measures used to ensure fiscal responsibility

g. Define state and federal regulatory requirements related to the practice site

3. Promote Public Health

a. Create awareness of major public health problems

b. Promote screening and prevention of diseases affecting public health

c. Aid patients in obtaining resources necessary for public health improvement

d. Gain an understanding of the role of insurance in healthcare as it pertains to

prescription medications

4. Be a resource for drug information

a. Retrieve, interpret and present drug information as requested by preceptor or other

staff

b. Utilize resources to apply evidence based medicine to practice

General Outcomes

1. Communicate effectively using a variety of media

2. Demonstrate sensitivity to personal values and ethical principles in professional and social

contexts (Responsible use of values and ethical principles)

3. Demonstrate progression in customer service skills (e.g. handling angry customers/patients)

and conflict resolutions

4. Effectively self-assess and satisfy learning needs on an ongoing basis (Self-Learning Abilities

and Habits).

5. Demonstrate effective interpersonal and interdisciplinary behaviors in a variety of situations

and circumstances (Social Interaction and Citizenship).

___________________________________________

†Professional and General Outcomes compiled from the following sources:

1. LECOM School of Pharmacy Curricular Outcomes, Academic Catalog and Student Handbook. 100-101.

2. Accreditation Council for Pharmacy Education (2011). Accreditation standards and guidelines for the

professional program in pharmacy leading to the doctor of pharmacy degree (Version 2.0). Chicago, IL.

Appendix B

3. Haase, K., K., Smythe, M. A., Orlando, P. L., Resman-Targoff, B. H., & Smith, L.S. (2008). ACCP white

paper: Quality experiential education. Pharmacotherapy, 28 (10), 219e-227e.

4. Joint ASHP-ACPE Taskforce (2011). Entry-level competencies needed for pharmacy practice in hospitals and

health-systems (Fall 2010). Bethesda, MD.

5. Institute of Medicine (2001). Crossing the quality chasm: A new health system for the 21st century.

Washington, DC: National Academy Press.

SUCCESS Competencies

The following seven competencies from the SUCCESS model developed collaboratively by the

Schools of Pharmacy in Florida have been selected as appropriate for IPPE rotations. These may

be referred to to support specific activities and feedback throughout the rotations. A complete

list of all thirteen competencies and the evaluation rubric may be accessed at

http://copnt13.cop.ufl.edu/doty/success/help/.

1. Drug Distribution Systems

a. Applies principles of civil law to the practice of pharmacy.

b. Applies state and federal regulations in the dispensing process.

c. Determines need and factors for correctly using the medication.

d. Identifies drug costs to the patient.

e. Clarifies, adds and/or corrects prescription order information when necessary.

f. Correctly labels and performs the final check.

g. Correctly documents adverse drug reactions through the appropriate channels.

h. Applies ordering, purchasing and inventory control principles.

i. Abides by laws on storage and disposal of medication.

2. Patient Interviews

a. Introduces self as student from College of Pharmacy.

b. Optimizes environment for the interview.

c. Clarifies the purpose and structure of the interview.

d. Verifies patient name and correct pronunciation, and demographic data.

e. Explains how patient will benefit from interview.

f. Employs vocabulary, question structure, question complexity, and invited

feedback to ensure patient understanding.

g. Implements the interview in an organized fashion.

h. Answers patient questions providing appropriate and correct data.

3. Patient Education/Counseling

a. Speaks clearly using proper enunciation, volume, and rate.

b. Uses terminology specific to the understanding of the patient.

c. Uses appropriate non-verbal communication.

d. Provides accurate and pertinent information in appropriate detail.

e. Includes information required for the patient’s social and financial needs.

f. Provides feedback to patient questions/concerns.

g. Determines patient level of understanding by asking questions.

h. Demonstrates empathy.

i. Shows concern for patient well-being.

j. Retrieves and evaluates new information for the purpose of responding to patient

questions.

4. Drug Information

a. Selects the best available resource for answering a drug related request.

http://copnt13.cop.ufl.edu/doty/success/help/

b. Demonstrates the ability to use other information resources (this includes poison

control centers, pharmaceutical companies and federal agencies).

c. Generates correct answers to questions in a timely and systematic manner.

d. Can define primary, secondary and tertiary references.

5. Professional Team Interaction

a. Dresses appropriately for the setting.

b. Demonstrates sensitivity for patients and families during team activities.

c. Demonstrates respect for other health care professionals.

d. Uses interpersonal communication skills to facilitate team interactions.

e. Actively participates in team activities.

f. Assists team members in establishing therapeutic and/or diagnostic objectives.

g. Uses documentation, persuasion, and alternative suggestions to resolve

therapeutic disagreements.

h. Provides accurate, organized, and pertinent information relevant to the team’s

current or future tasks.

i. Follows up on questions asked by the team in a timely fashion.

j. Interactions with the team are conducted with an appropriate level of confidence.

k. Retrieves and evaluates new information for the purpose of responding to

professional questions.

6. Professionalism/Motivation

a. Identifies and respects the values of others.

b. Demonstrates knowledge and understanding of the pharmacist “code of ethics.”

c. Defends ethical decisions through analysis of ethical principles.

d. Demonstrates sensitivity to confidentiality issues.

e. Attends and participates in all activities according to attendance policies.

f. Is punctual for all activities.

g. Completes assigned responsibilities (including patient care responsibilities) on

time.

h. Accommodates to change in workflow without disruption of work schedule.

i. Initiates additional learning opportunities.

j. Synthesizes new information in order to draw conclusions, hypothesizes, or

decides a course of action.

7. Cultural Sensitivity

a. Assesses the religious and socio-economic value systems that affect need and

adherence.

b. Possesses the knowledge, skills and behaviors required to identify communication

tools to accommodate a culturally diverse population.

c. Identifies cultural differences that will potentially affect professional interactions.

d. Identifies appropriate alternative measures to improve verbal and non-verbal

interactions between patient and pharmacist.

Rotation Policies & Regulations

The student is required to share the rotation manual with their preceptor at the beginning

of the rotation. A student that does not may lose 5% from their grade. The student is

responsible for reading the content of the rotation manual and is expected to follow the policies

and regulations as stated. Any infringements can lead to deductions in grade, automatic

dismissal from the site, and/or failure of the rotation.

I. Pre-requisites

1. Be in good academic standing after the first academic year.

2. Health Documents - Students must have all up-to-date school and site required health

records (physical examination, immunizations, 2 step-PPD, influenza vaccine, etc.) prior

to starting rotations. Students must keep a copy of your health records with you so you

may present them at the site when requested. 3. Intern Licenses – Student must have an intern license for all states in which they will have

rotations. Students must have their intern license with them at all times while on

rotation.

4. Background Checks, etc. – Student must complete the background check, fingerprinting

and drug screens as required by the rotation sites, including their required timeframes.

Instructions for completing these checks through Certiphi, FieldPrint or other appropriate

mechanisms are described in another section of this manual. Students scheduled for out-

of-state rotations may have different requirements that will need to be determined when

preparing for that specific rotation. NOTE: The VA system has specific internal

procedures for completing background checks and must be contacted 6 weeks prior

to the start of the rotation.

**If a student chooses to complete any of these screens through a different vendor, LECOM

will not be able to verify completion or sign off on required documents for the sites. This will

result in increased cost to the student (when they need to order and complete the screens

through the vendors noted above) and may result in delay or cancellation of the rotation.

5. OSHA/HIPAA Training – If required, the student will complete the required on-line

training modules on The Pharmacist’s Letter as instructed by the school.

6. All documents must be filed with the Director of Experiential Education

according to the due date. Failure to adhere to this policy will result in the

delay of your rotation.

7. Students are required to contact their respective preceptor/site and send their

CV at least 4-6 weeks prior to their start date. An exception is VA sites, which

must be contacted at least 6 weeks prior to the start of the rotation. Failure to provide

necessary information to sites or the Office of Experiential Education may result in

cancellation of the rotation, which will need to be made up at a later date, potentially

delaying graduation.

II. Attendance policy

1. Time requirements:

All students are expected to adhere to the rotation attendance policy. All students are

required to spend a minimum of 40 contact hours per week at the site. Students are

expected to be on time. Repetitive tardiness will result in failure of the rotation.

Students are not permitted to work “ahead” hours to shorten their rotation.

2. Absences:

a. Absences with Advanced Notice: A student may make a request to be excused

from rotation for a qualifying school-sponsored or other educational event. In these

cases, an “Experiential Absence Request/Report Form” (available on the LECOM

portal) needs to be completed by the student then signed and approved by their

preceptor and the Director of Experiential Education at least ten (10) working days

in advance. Failure to adhere to this policy will result in missing days being

counted as unexcused absences. Any non-emergency absence that is NOT

documented on this form will result in a ten percent (10%) deduction of the

student’s rotation grade. A site may be audited at any time to ensure that the

student is present.

b. Unplanned Absences (e.g. Illness or Emergency): In the event that the student

must be unexpectedly absent from rotation, the student must immediately notify

BOTH the preceptor (by phone) and the Administrative Assistant of the

Office of Experiential Education (941-782-5676). Additionally, you must

document the absence with an “Experiential Absence Request/Report Form” which

is located on the portal. Please treat your preceptor as you would an employer and

provide notice as early as possible. In the event that the student must leave a

message, (s)he should provide a contact phone number where (s)he may be

reached and follow up with an e-mail (if possible) to ensure that the message was

received. Each failure to notify the preceptor AND the School properly will

result in a five percent (5%) deduction from the student’s rotation grade.

c. Students who miss more than three (3) days per rotation, for any reason, will

fail the rotation, and the rotation MUST be remediated and may consequently

delay graduation. All but one (1) missed day (for any reason) must be made

up. Documentation of plans for making up this time must be included on the

“Absence Request Form.”

d. Examples of excused absences include (list is non-inclusive):

i. Attendance at professional meetings

ii. Attendance at school-sponsored events (e.g. Career Day)

iii. Required legal appointments (e.g. jury duty, immigration

appointments)

iv. Emergency situations (may result in rescheduling of rotation)

3. Please note that a site may be audited by phone or in person at any time and student

attendance will be one aspect reviewed.

III. Professional liability insurance

LECOM arranges for liability insurance for students each year. If the site requests

verification of LECOM liability insurance, they may contact the Office of Experiential

Education and a copy of the insurance certificate will be sent to the site.

IV. Site selection / Site Audits

1. Students generally are not authorized to perform their rotations at the same site where a

co-existing or previous employer/employee relationship exits or under the direct

supervision of a family member. Students may complete more than two rotations at the

same location (including both IPPE and APPE) as long as a substantial difference in the

learning experience can be demonstrated.

2. Students are responsible for expenses associated with the rotation. Students will not accept

any remuneration from the site.

3. Rotation dates are firm and CANNOT be changed except for extreme hardships and must be

approved by the Director of Experiential Education. A “Rotation Change Request” (located

on the portal) must be completed and submitted to the Director of Experiential Education to

document the reason for the request.

4. Students should be sure to inform the Office of Experiential Education immediately if

there is a change in their assigned Preceptor of Record.

5. Preceptors may refuse a student from attending a site or expel a student from a current site per

the site’s agreement with LECOM. If a student is expelled from a site, the student must

contact the Director of Experiential Education for further guidance. Expulsion may disqualify

a student from graduation or delay the graduation date.

6. A site visit may occur by phone or in person to audit the compliance with rotation

requirements.

V. Rotation portfolio

All students shall maintain a rotation portfolio. All assignments required and all work

accomplished during the rotations should be kept and presented to the preceptor at each

site for review on the first day of the rotation. The portfolio will help you to keep track

of your own accomplishments as well as to inform your preceptor about your activities

during previous rotations. You will continue to build your portfolio through the rest of

the curriculum and during your APPEs.

Portfolios must be maintained and presented to your Advisor within two (2) weeks of

returning to campus for the didactic portion of the Fall term of your P2 year. The

Advisor will be responsible for review of and assignment of 10% of each of your IPPE

grades. Failure to present your portfolio with pertinent assignments for review within

the two (2) week time frame will result in a loss of 10% of your grade. You must also

present your portfolio to the Office of Experiential Education immediately upon request.

The following is recommended for your portfolio:

Format

o 3-Ring binder

o Use divider tabs for “documents” and for each rotation.

Contents

o Required documents

Curriculum vitae (CV)

Intern license(s)

Immunization records

Background check, if available

HIPAA/ OSHA Training Certificates, if applicable

Other important required information for individual sites

Other: Copy of the printed rotation manual (optional) and site contact form.

o Completed assignments/ reflections/ projects

As outlined in the Assignments section of the manual

o Evaluations- any written feedback by preceptor, including presentation evaluations

and rotation midpoint and final evaluations

VI. Evaluations

All rotation evaluations are to be completed in PharmAcademic. Failure to adhere to

this policy will result in an incomplete grade until all documents are received by the

Director of Experiential Education.

Preceptor:

At the midpoint (2 weeks) and end of each rotation (4 weeks), the preceptor will

complete an evaluation of the student and review it with them.

The student must be informed of any concerns regarding deficiencies that may

jeopardize their ability to successfully pass the rotation. The preceptor should contact

the Director of Experiential Education immediately and forward the Midpoint

Deficiency Notification if there is a concern of the student failing the rotation.

Student:

The student must perform a Midpoint and Final Self-Assessment, print it and have it

available for evaluation discussions with their preceptor.

At the end of the rotation, the student will complete an evaluation of the preceptor and

the rotation site.

VII. Grading

Preceptor- Assignment Completion/ Overall IPPE Evaluation: 90%

Advisor- Review of Student Portfolio: 10%

100%

Grading will be a letter grade similar to the grading during the didactic portion of your

education at school. The evaluation will be performed by the preceptor at mid-rotation

and at the end of the rotation, at which time a final grade will be assigned.

Grade scale

A - Excellent (Numerical Range 89.5-100)

B - Good (Range 79.5-89.4)

C - Satisfactory (Range 69.5-79.4)

F - Failure (Range of 69.4 or below)

Deductions of 5% (more if specified) may be made to the final grade for violations of

any of these policies or regulations.

VIII. Weather conditions

All students should follow the weather advisory from their rotation site regarding

cancellation or delay of the rotation. However, the students who cannot travel to the site

due to hazardous weather conditions should immediately notify their preceptors and the

Administrative Assistant to the Director of Experiential Education (941-782-5676).

Attendance policy still applies regarding making up days and missing days.

IX. Dismissal from sites

All students are representing LECOM and the pharmacy profession during their presence

at the rotation site. Therefore, professionalism and the highest standards are expected

from all students during their training at the site. LECOM and the site reserve the right to

dismiss any student who does not uphold a professional attitude during the rotation or if

the student does not meet academic standards. Additionally, rotation sites maintain the

right to remove a student from the site if the student does not comply with safety, ethical,

or treatment standards of the rotation site. Any student under the influence of any

substance of abuse or caught stealing (drugs, money, etc.) from the site will be also be

dismissed. Any student dismissed from a site will automatically fail the rotation.

Both the preceptor and the student should contact the Director of Experiential

Education immediately. The incident will be forwarded to the Academic Standing and

Promotion (ASP) Committee.

X. Academic Honesty & Plagiarism

Any violation of the Academic Honesty Policy and Plagiarism as defined in the student

handbook will not be tolerated. Violators will be subject to disciplinary action, which may

include failure of the rotation.

Examples of dishonesty and plagiarism include, but are not limited to:

1. Not using own work for an assignment

2. Reusing projects for multiple rotations, unless using them as reference

3. Using slides from course lectures for rotation presentations

XI. Professionalism

As consistent with the expectations of a professional and practice environment,

professional behavior and attitudes are expected of all students enrolled in this rotation.

Examples of professional behavior include, but are not limited to: appropriate

demeanor/attitude, ethics, dress/grooming, punctuality, and civility.

Cell phones should not be directly with the student except when it has been approved

beforehand by the preceptor for a specific and valid reason (e.g. electronic drug

reference). Under no circumstances should a student text, make calls, or check/post to

social media sites during rotation, unless on break. Any reports by preceptors to the

School regarding violations to this policy will result in a 5% deduction in the rotation

grade on top of any deductions taken by the preceptor on the student’s overall evaluation.

XII. Dress code

All students should wear their lab coat with appropriate logo from the LECOM School of

Pharmacy with their name during the rotation time. No jeans, short skirts, revealing

clothing, sandals, or sneakers are allowed. All students should be well groomed. No

extensive jewelry, perfume, earrings, or long hair are allowed. Good body hygiene is to

be observed. Preceptors/sites may have a specific dress code requirement that students

must follow while on rotation. This includes both attire and appearance (e.g. no facial

hair, tattoos, artificial nails).

XIII. Confidentiality & HIPAA

Patient information is private. Confidentiality is a foundation for the establishment of

trust between patients and health care providers; patients permit pharmacists to look into

their private health information in order to carry out their duties. The students are

expected not to discuss or divulge in any manner (intentional or otherwise) any patient

information that they have learned from their rotation sites outside of their learning

environment. Any infraction will result in immediate dismissal from the site and a

failing grade will be given for the rotation.

If required by the rotation site, students will complete the HIPAA Privacy and Security

Training via The Pharmacist’s Letter as directed by the Office of Experiential Education.

XIV. Verification of Site and Preceptor Information in PharmAcademic

All students will verify the information contained in PharmAcademic regarding their

preceptor and site on the first day of the rotation including preceptor; spelling of

preceptor name; preceptor address, phone number, fax number, and e-mail address (if

available); site name, address, phone number, and fax number. The student will notify

the Administrative Assistant for Experiential Education (941-782-5676) of any incorrect

information and provide the correct information as soon as possible by e-mail. Failure to

do this may impact the evaluation process and may delay the rotation

Introductory Pharmacy Practice Experience (IPPE)

Rotation Descriptions

Institution IPPE Rotation

PHR1002 PH2-B

COURSE INFORMATION:

This is a 4 week, full- time experiential program (40 hours/week minimum on-site; additional time

required for assignment and project completion) scheduled at the beginning of the fall semester of

the P2 year. The location is an assigned pharmacy providing inpatient services.

Credit Hours: 4

COURSE DESCRIPTION:

The goal of this rotation is to have the student become competent in the daily practice of

institution pharmacy operations through active learning and participation. The emphasis is on

the operations, distribution system and professional conduct in the inpatient environment. This

will serve as a basis for understanding the provision of patient-centered care in the inpatient

setting. The following three (3) steps of the medication-use system will be emphasized:

selecting, procuring and storing; ordering and transcribing; and dispensing and preparation.

COURSE RATIONALE:

Understanding the system of how medications are handled in the two most common practice

environments (community and institution) will greatly benefit the students as they apply both

distribution and clinical knowledge gained in didactic coursework throughout the curriculum to

patient care. The students will gain an appreciation of the “whole picture” of the medication-use

system, which includes the following steps: selecting, procuring and storing; ordering and

transcribing; dispensing and preparation; administering; and monitoring.

REQUIRED AND SUGGESTED TEXTBOOKS AND MATERIALS:

LECOM IPPE Rotation Manual

Center for the Advancement of Pharmaceutical Education (CAPE) Educational Outcomes 2004

Handbook of Nonprescription Drugs, Berardi, Rosemary R, APhA publications; 15th

edition,

2006. ISBN 0889-7816

Law References:

1. Pharmacy Law Digest (Bound), Facts and Comparisons; 40th

edition, 2006. ISBN 1574392247

2. Code of Federal Regulations, Title 21, Food and Drugs, Pt. 1300-End, Revised as of April 1,

2007. ISBN 0160782422

3. Florida Statutes and Board of Pharmacy Rules and Regulations previously distributed:

a. Florida Pharmacy Act – Florida Statutes Title XXXII, Chapter 465

b. State Board Rules and Regulations – Chapter 64B16

c. Poison Prevention Packaging: A Guide for Health Care Professionals

Lexicomp (or other similar drug information sources) - available through the LECOM Learning

Resource Center.

AVAILABILITY OF COURSE MATERIALS:

An electronic copy of the LECOM IPPE Manual (including rotation assignments) and the CAPE

Educational Outcomes 2004 will be provided for every student on the portal. Students are

required to have the IPPE Manual, textbook(s) and legal references (already purchased for

previous classes) accessible while at their rotation site. Internet access is required for e-mail

contact and access to the LECOM LRC. Students will be informed as to other materials that may

be needed for the rotation as appropriate.

SPECIFIC COURSE & INSTRUCTOR POLICIES:

The LECOM School of Pharmacy Introductory Pharmacy Practice Experiences (IPPE) Rotation

Manual provides a detailed description of rotation policies. The student is responsible for

reading the content of the IPPE manual and is expected to follow the policies and regulations as

stated. Any infringements can lead to automatic dismissal from the site and failure of the

rotation.

ASSIGNMENTS & ACADEMIC CALENDAR:

The students will complete required assignments designed by LECOM School of Pharmacy to

develop and assess basic competencies. Preceptors may include additional assignments.

Completion of these assignments may be based on actual experience at the rotation site or, if the

experience does not present during the rotation dates, a simulated example approved by the

preceptor. Assignments may be worked on while physically present at the rotation site but will

also need to be addressed “after hours.” The expectation is for the student to be at the rotation

site a minimum of 40 hours/week. Extra time on-site may be required depending on the

workflow of the pharmacy. Time spent working on assignments may entail an additional 10-20

hours/week.

SCHEDULE OF ROTATION ACTIVITIES

This schedule is subject to change at the discretion of the preceptor.

Date Activities Responsible Party

4 weeks

(minimum)

Prior to

Rotation

Contact Preceptor and provide CV Student

Week 1 Day 1: Site/Rotation Orientation Preceptor

Day 1: Portfolio and IPPE Manual review Student

Initiate competency assignments Student

Week 2 Continue competency assignments Student

Complete mid-point evaluation Preceptor / Student


Week 4 Complete competency assignments Student

Complete final evaluation Preceptor / Student

Complete preceptor/site evaluation Student

TBD Participate in competency and “de-briefing” session following

return to campus

Dr. Stevenson

Community IPPE Rotation

PHR1001 PH2 – B

COURSE INFORMATION:

This is a 4 week, full- time experiential program (40 hours/week minimum on-site; additional time

required for assignment and project completion) scheduled at the beginning of the fall semester of

the P2 year. The location is an assigned pharmacy providing outpatient, community services.

Credit Hours: 4

COURSE DESCRIPTION:

The goal of this rotation is to have the student become competent in the daily practice of

community pharmacy operations through active learning and participation. The emphasis is on

the operations, distribution system and professional conduct in the community environment.

This will serve as a basis for understanding the provision of patient-centered care in the

community setting. The following three (3) steps of the medication-use system will be

emphasized: selecting, procuring and storing; ordering and transcribing; and dispensing and

preparation.

COURSE RATIONALE:

Understanding the system of how medications are handled in the two most common practice

environments (community and institution) will greatly benefit the students as they apply both

distribution and clinical knowledge gained in didactic coursework throughout the curriculum to

patient care. The students will gain an appreciation of the “whole picture” of the medication-use

system, which includes the following steps: selecting, procuring and storing; ordering and

transcribing; dispensing and preparation; administering; and monitoring.

REQUIRED AND SUGGESTED TEXTBOOKS AND MATERIALS:

LECOM IPPE Rotation Manual

Center for the Advancement of Pharmaceutical Education (CAPE) Educational Outcomes 2004

Handbook of Nonprescription Drugs, Berardi, Rosemary R, APhA publications; 15th

edition,

2006. ISBN 0889-7816

Law References:

1. Pharmacy Law Digest (Bound), Facts and Comparisons; 40th

edition, 2006. ISBN 1574392247

2. Code of Federal Regulations, Title 21, Food and Drugs, Pt. 1300-End, Revised as of April 1,

2007. ISBN 0160782422

3. Florida Statutes and Board of Pharmacy Rules and Regulations previously distributed:

a. Florida Pharmacy Act – Florida Statutes Title XXXII, Chapter 465

b. State Board Rules and Regulations – Chapter 64B16

c. Poison Prevention Packaging: A Guide for Health Care Professionals

Lexicomp (or other similar drug information sources) - available through the LECOM Learning

Resource Center.

AVAILABILITY OF COURSE MATERIALS:

An electronic copy of the LECOM IPPE Manual (including rotation assignments) and the CAPE

Educational Outcomes 2004 will be provided for every student on the portal. Students are

required to have the IPPE Manual, textbook(s) and legal references (already purchased for

previous classes) accessible while at their rotation site. Internet access is required for e-mail

contact and access to the LECOM LRC. Students will be informed as to other materials that may

be needed for the rotation as appropriate.

SPECIFIC COURSE & INSTRUCTOR POLICIES:

The LECOM School of Pharmacy Introductory Pharmacy Practice Experiences (IPPE) Rotation

Manual provides a detailed description of rotation policies. The student is responsible for

reading the content of the IPPE manual and is expected to follow the policies and regulations as

stated. Any infringements can lead to automatic dismissal from the site and failure of the

rotation.

ASSIGNMENTS & ACADEMIC CALENDAR:

The students will complete required assignments designed by LECOM School of Pharmacy to

develop and assess basic competencies. Preceptors may include additional assignments.

Completion of these assignments may be based on actual experience at the rotation site or, if the

experience does not present during the rotation dates, a simulated example approved by the

preceptor. Assignments may be worked on while physically present at the rotation site but will

also need to be addressed “after hours.” The expectation is for the student to be at the rotation

site a minimum of 40 hours/week. Extra time on-site may be required depending on the

workflow of the pharmacy. Time spent working on assignments may entail an additional 10-20

hours/week.

SCHEDULE OF ROTATION ACTIVITIES

This schedule is subject to change at the discretion of the preceptor.

Date Activities Responsible Party

4 weeks

(minimum)

Prior to

Rotation

Contact Preceptor and provide CV Student

Week 1 Day 1: Site/Rotation Orientation Preceptor

Day 1: Portfolio and IPPE Manual review Student

Initiate competency assignments Student


Complete mid-point evaluation Preceptor / Student


Week 4 Complete competency assignments Student

Complete final evaluation Preceptor / Student

Complete preceptor/site evaluation Student

TBD Participate in competency and “de-briefing” session following

return to campus

Dr. Stevenson

Rotation Assignments

The assignments included in this manual have been designed for application of knowledge and skills

taught during the first didactic year. The manual contains titled sections that provide descriptions and

worksheets for specific assignments. The following table identifies the competency area and the

related assignments:

Competency

Area

Community Site

Assignment

Institution Site

Assignment

When it

is due for

review by

preceptor

Distribution

Systems

Rotation Site Description Rotation Site Description Midpoint

Professional

Growth

Reflection Reflection Midpoint

and Final

Drug

Information

OTC Formulary/

Related Products Reference

Drug Information

Question(s)

Midpoint

and/or Final

Patient Care SOAP Note

Medication History Final

1. The assignments listed in the pertinent column are required. Additional assignment

suggestions are provided in the manual. These and/or additional site or rotation-specific

assignments may be assigned at the discretion of the preceptor.

2. All assignments should be reviewed for satisfactory completion and “scored” as part of

the Final Assessment by the preceptor using the Excellent, Competent, and Deficient

criteria. They should then be included in the student’s portfolio when completed for review

by preceptors, the student’s advisor, or the Office of Experiential Education.

General guidance for a quality assignment:

The student displayed initiative, independence, motivation and effort to complete the assignment.

Moderate preceptor intervention was required to complete the assignment.

Minimal to moderate corrections were necessary upon review of the final assignment by the

preceptor.

Grammar, organization, style and formatting were appropriate.

The final assignment was deemed competent to excellent.

Assignment I - Required

Rotation Site Description

Directions:

1. Complete the data collection worksheet for the practice site by interviewing your

preceptor and other healthcare professionals. Select the data collection worksheet

appropriate to the rotation site.

2. Answer the additional points below by interviewing necessary personnel.

3. Write a paper describing the site incorporating the data collected. The assignment must

be done individually by each student and be written in your own words. a. Description to be typewritten and 2-3 pages in length or as directed by your

preceptor.

b. You will place both the completed data collection worksheet and the paper to

your portfolio.

Additional points to address:

Describe the physical layout of the pharmacy practice setting.

Describe the personnel of the pharmacy, including job titles and primary responsibilities.

o Include the number of FTE’s (full time equivalents).

Specifically discuss your primary preceptor’s role and responsibilities.

Discuss the organizational chart (reporting structure) for the pharmacy.

Describe the services and activities provided by the pharmacy.

o Include a discussion of non-pharmacy interactions, if applicable. Examples

include interactions with departments or services external to the pharmacy.

Describe the workflow in the pharmacy on an average day.

Describe how the site is involved in the training of pharmacy students.

Site Data Collection Worksheet – Institution

Adapted from American Association of Colleges of Pharmacy Academic-Practice Partnership

Initiative, pilot project to profile exemplary advanced practice experience sites (completed

September 2005)

Part 1 – General Descriptive Criteria

1. Site Name:

2. Location: Address:

City:

State:

ZIP:

Phone:

Fax:

Website:

3. Patient Types: □ Acute

□ Ambulatory

□ Extended Care

4. Pharmaceutical care

is a primary focus of

practice

□ Yes

□ No

5. Approx. % of patient

types

Pediatric % Geriatric % Other:

%

Adult % Hospice %

6. Number of

pharmacists

FTE (full-time equivalents)

PTE (part-time equivalents)

7. Number of

technicians



8. Site affiliates with

other academic

institutions

□ Yes List schools:

□ No

9. Number of

specialized positions



10. Site is an accredited

residency site

□ Yes Accrediting Agency:

□ No

11. Number of residents

and type

PGY1:

Hospital:

Community:

Managed Care:

Home Care:

Long-Term Care:

Ambulatory Care:

Family Practice:

PGY2:

Management:

Clinical pharmacokinetics:

Critical Care:

Drug Information:

Geriatrics:

Infectious Diseases:

Internal Medicine:

Nuclear Pharmacy:

Nutrition Support:

Oncology:

Pediatrics:

Pharmacotherapy:

Primary Care:

Psychiatric Pharmacy:

Other (describe):

1. Practice Type □ Hospital

□ Extended Care

□ Other (describe):

2. Institution Size # of beds:

3. Average census

4. Basic Hospital

Services (check all

that apply)

□ Medical / Surgical

□ Pediatrics

□ Neonatal ICU

□ Pediatric ICU

□ ICU

□ ER

□ Trauma Center

□ OB/Gyn

□ Oncology

□ Psychiatry

□ Ambulatory Care

□ Infectious Disease

□ Other (describe:

5. Distributive services

provided

□ Centralized unit dose distribution

□ Decentralized unit dose distribution

□ IV preparation

□ TPN compounding

□ Chemotherapy compounding


6. Non-distributive

services provided

□ Patient rounds

□ Pharmacokinetics

□ Therapeutic consults

□ IV to PO conversion

□ Drug information

□ Newsletter provision

□ P&T Committee/Formulary development

□ Nursing/Physician/Other Healthcare Practitioner education

□ Chart writing privileges

□ Laboratory test order protocol

□ Code Blue participation

□ ER service

□ OR service

□ Infectious Disease service

□ Nutritional Support service

□ Anticoagulation service

□ Pain Management service

□ Formal patient education programs


7. Patients monitored/

RPh practitioner/day

Average #:

8. Patient identification

for non-distributive

services

Describe (e.g., physician referrals, lab results, etc.):

9. Pharmaceutical Care

documentation

system

Describe:

10. Automation □ Baker cells/counting machines

□ Barcode scanning

□ Interactive voice response (IVR)

□ IV automation system (describe):

□ Medication dispensing cabinets (describe):

□ Robot/ScriptPro (describe):


11. Economics of

practice (%):

Insurance:

Medicare:

Medicaid:

Private pay:

Cash:

Student Name (print):

Student Signature:

Rotation Dates:

Site Data Collection Worksheet -Community

Adapted from American Association of Colleges of Pharmacy Academic-Practice Partnership

Initiative, pilot project to profile exemplary advanced practice experience sites (completed

September 2005)

1. Site Name:

2. Location: Address:

City:

State:

ZIP:

Phone:

Fax:

Website:

3. Patient Types: □ Acute

□ Ambulatory

□ Extended Care


is a primary focus of

practice

□ Yes

□ No

5. Approx. % of patient

types

Pediatric % Geriatric % Other:

%

Adult % Hospice %

6. Number of

pharmacists



7. Number of

technicians



8. Site affiliates with

other academic

institutions

□ Yes List schools:

□ No

9. Number of

specialized positions



10. Site is an accredited

residency site

□ Yes Accrediting Agency:

□ No

11. Number of residents

and type

PGY1:

Community:

Other (describe):

PGY2:

Community:

Other (describe):

Pharmacy area

(square feet)

1. Drive through

window

□ Yes

□ No

2. Average Rx’s per

day

3. Front-end square

footage and products

Square feet:

Products:

□ OTC

□ Supplements

□ Herbals

□ Homeopathic

□ Diagnostics/monitoring devices

□ Medical supplies


4. Description of

services

Medication Therapy Management in:

□ Anticoagulation

□ Asthma

□ Diabetes

□ CHF

□ Hyperlipidemia

□ Hypertension

□ Metabolic Syndrome

□ Smoking cessation

□ Weight loss

□ Women’s health

Other:

□ Compounding

□ Durable Medical Equipment (DME)

□ Home IV and Hyperalimentation

□ Emergency contraception

□ Immunizations

□ Medication counseling

□ Health screenings

□ OTC consultations

□ Polypharmacy management

□ Skilled Nursing Home consulting

□ Patient medication assistance

Other (describe):

6. Patients monitored/

RPh practitioner/day

Average #:

7. Patient care

workflow for MTMS

(how are they

referred/seen/etc.)

Describe (referrals, walk-ins, etc.):


documentation

system

Describe:

9. Documentation

format and feedback

□ SOAP Notes


How is information provided to patient and to patient’s

physician (describe)?

10. Automation □ Baker cells/counting machines

□ Barcode scanning

□ Interactive voice response (IVR)

□ IV automation system (describe):

□ Robot/ScriptPro (describe):


11. Economics of

practice (%)

Insurance:

Medicare:

Medicaid:

Private pay:

Cash:

12. Billing for MTMS Describe (include success):

Student Name (print):

Student Signature:

Rotation Dates:

Assignment II - Required

Reflection Paper

Write two (2) reflections for both IPPE rotations. The first will be at the end of the second

week (midpoint) and the second will be at the completion (final) of the rotation. Include the

aspects noted below and any additional information you feel important in your development as

a pharmacist. Each reflection should be 2‐3 pages, typed and double‐spaced. Submit to your

preceptor the day before your midpoint and your final evaluations, unless otherwise requested

by your preceptor. Please print a copy for your portfolio and retain an electronic version of

this reflective exercise. The Office of Experiential Education may request that you send a

copy at any time. Pre‐Planning:

Determine your specific goals and objectives to attain during your rotation experience.

Both reflections need to include the following title information:

1. Student name

2. Title to include midpoint or final reflection

3. Date of reflection

4. Preceptor name

5. Site name

6. Rotation type (community or institution) and dates

Midpoint Reflection (due the day before your 2-week Midpoint evaluation):

1. Identify what you thought you would experience during the first two (2) weeks of the rotation,

including your goals and objectives, and compare to your actual experience.

2. Summarize your activities and experiences during the first two (2) weeks of the rotation.

3. Describe at least one (1) example of behaviors or characteristics you observed among the pharmacy

employees and how they positively or negatively affect the delivery of services.

4. Identify at least one (1) area of pharmacy practice you participated in that was covered in pharmacy

coursework during your P1 year.

5. Identify specific goals for the final two (2) weeks of the rotation.

Final Reflection (due the day before your FINAL evaluation):

1. Identify what you thought you would experience during the last two (2) weeks of the rotation,

including your goals and objectives, and compare to your actual experience.

2. Summarize your activities and experiences during the last two (2) weeks of the rotation.

3. Describe at least one (1) additional (and different) behavior or characteristic you observed among the

pharmacy employees and how they positively or negatively affect the delivery of services.

4. Identify at least one (1) additional area of pharmacy practice you participated in that was covered in

pharmacy coursework during your P1 year.

5. Describe how you have been changed by this rotation experience and how it has helped you in your

development as a pharmacist. Include an assessment of strengths and weaknesses you identified in

yourself during this rotation.

Grading Criteria:

1. All title information is included.

2. Reflection is 2-3 pages, typed and double-spaced.

3. Sentences are complete and free from grammatical errors.

4. Goals are clearly stated.

5. Experiences and activities are clearly summarized.

6. Description and outcome of pharmacy employees’ behaviors and characteristics are clearly

described.

7. At least one (1) aspect of the pharmacy coursework was clearly related to the rotation experience.

8. Strengths and weaknesses were clearly described.

9. The impact of the rotation on professional growth as a pharmacist is clearly addressed.

Assignment III- Institutional Requirement

Drug Information Question Worksheet

Final results to be typed for inclusion in student portfolio. Refer to the following guide for

processing questions.

Requestor Name (if patient, use initials):

Question asked:

ULTIMATE/REAL Question:

Introduction (state pertinent background provided that sets the context for the response):

Information / data found regarding question:

Conclusion / Recommendations (information / data above must support conclusion):

References (cite reference completely):

Student Name (print): Date:

Student Signature:

Preceptor Name (print): Date:

Preceptor Signature:

Drug Information Question Processing

Modified Systematic Approach

(Host TR, Kirkwood CF. Abstract presented as ASHP Midyear Clinical Meeting; Dec 1987)

Steps: 1. Identify caller

2. Obtain background information*

3. Determine and categorize ultimate question

4. Develop search strategy and conduct search

5. Perform evaluation, analysis, and synthesis

6. Formulate and provide response

7. Conduct follow-up and documentation

*Background Information to determine:

Regardless of type of question:

Requestor’s name

Requestor’s location and/or contact info

Requestor’s affiliation, if healthcare professional

Requestor’s title, profession

Resources requestor has already contacted

Request patient specific or not

Patient’s diagnosis and other meds

Urgency of request

Adverse Drug Reaction:

Obtain description of the event and assess severity

Temporal relationships

Signs/symptoms

Concomitant medications

Assess current status of patient

How is the patient being managed?

Previous history of exposure to same or similar agents

Drug Interactions:

Obtain description of the problem – is the patient already taking

the drugs or is this in anticipation of starting a drug?

Doses, duration of therapy, rates of administration?

Temporal relationship between the drugs in question

Other medications

Is a disease-drug or food-drug interference a possibility?

Foreign drug identification:

Reason for inquiry

US equivalent needed

Suspected form, strength, dosing regimen, color, markings

Where did the spelling come from?

Product availability:

Indication for treatment

Dosage form/ route of administration desired

On formulary status required

Product ID: Correct spelling

Country of origin

Trade/generic/chemical name

Reason for inquiry

Suspected product and use

Manufacturer

Size/shape/strength, imprint markings, color

Where did you hear about the product?

How did you hear about this product?

Compatibility/stability:

How are drugs going to be mixed?

What are the concentrations of the drugs?

What diluent solutions are the drugs mixed in?

What are the doses and rates of infusion?

Any fluid/electrolyte restrictions?

Available routes for administration

How many IV lines are available?

What other medications are running?

Dosage/Administration:

Indication for the drug

Weight of the patient

Age/sex of patient

Renal and/or hepatic function

Planned route of administration

Other medications (drug interactions)

Drug of Choice/Therapeutics:

Exact indication and severity of condition

Renal and/or hepatic function

Concomitant medications

Concomitant medical conditions

Route of administration

Allergies

What other treatments has this patient tried for this condition? If

other tried, why were they stopped? (Lack of efficacy, adverse

effect)

Compliance and cost factors

Pharmacokinetics:

Reason for inquiry (treatment failure, low levels)

Dose and route of administration

Indication

Height, weight, age, sex of patient

Renal and/or hepatic function/protein status

Drug levels? Timing of levels? Believable?

Single versus multiple doses

Duration of therapy

Times levels drawn and what are the levels

Concomitant medications? Other physiologic conditions present

that can affect kinetics?

Pregnancy/ lactation:

Has the patient already taken the drug?

Indication for the drug

How essential is the drug

Planned dose, frequency, duration, and route of administration?

Other drugs or disease states?

Trimester of pregnancy

Fetal abnormality?

Symptoms following breast feeding

How old is the infant?

Frequency/schedule of breast-feeding

Is bottle feeding an option?

Compounding/ Formulation:

Reason for having to compound

What is the drug being used for?

Did the patient use another similar agent?? Result?

Dosage

Site of desired administration

Poison/ Toxicology:

Telephone number

Acute ingestions poison center

What was ingested – drug/chemical?

Amount ingested

Route of exposure

Time elapsed since ingestion

Accidental exposure? Suicide attempt? Environmental exposure?

What symptoms is patient having?

What has been done for the patient so far?

Renal and hepatic function

Pharmacology:

Reason for inquiry (often pharmacokinetics or drug interaction)

Patient’s disease state

Investigational drugs:

Reference sources (where did caller hear about the drug?)

Correct spelling (source of spelling)

Therapeutic use

Investigator manufacturer

Reason for inquiry (sometimes a toxicity/ adverse effects

question)

Assignment IV- Institutional Requirement

Medication History / Patient Interview Worksheet - Instructions

*All documentation to be turned in to the school or kept in the student portfolio must NOT

contain any patient identifiers.

IMPORTANT: LECOM School of Pharmacy feels that this is an important skill that must be

developed and practiced in our students. If this activity cannot be performed due to limited

opportunities at site, the following is recommended:

If the preceptor or other staff member is willing, perform an interview/med history using them

as your sample patient

The preceptor can create a “mock” patient script that they may use while the student conducts

the interview.

If multiple students are at the site, the preceptor can oversee the performance of actual or

mock medication histories on each other.

As a worst case scenario, the student may interview a family member, friend, or roommate in

order to complete the assignment.

*The following are examples of questions and points to discuss with patients to help obtain an

accurate medication history:

1. What medications are you currently taking?

2. What medications have your doctors told you to take?

3. What products do you buy to feel better that you don’t need a prescription for?

4. What product(s) do you take for…

a. A headache?

b. Aches and pains?

c. Cold/sinus symptoms (congestion, cough, runny nose, etc.)?

d. Allergy symptoms (itchy/watery eyes, runny nose, etc.)?

e. Stomach problems (upset stomach, constipation, diarrhea)?

5. What herbal/natural/vitamin products do you take?

Medication History / Patient Interview Worksheet

Interview Date: □ Male □ Female Age:

Source of information (e.g., patient, family member, etc.):

*Medication History (include all prescription, over the counter, supplements and herbal

products used by the patient); use additional page if necessary.

Medication

(name, strength, quantity/dose, route and frequency)

Last Taken

(Date/Time)

Indication/ Purpose/

Comments

Medication Allergies:

Medication name: Reaction:



Immunization Record (date/year of last dose if known):

Influenza Vaccine: Hepatitis Vaccine:

Pneumonia Vaccine: Tetanus Vaccine:

Zoster Vaccine: Other Vaccine:

Describe any potential medication related problems or other areas of concern:

Student Name (print): Date:

Student Signature:

Preceptor Name (print): Date:

Preceptor Signature:

Assignment V- Community Requirement

OTC Formulary / Related Products Reference

Create a document (2-3 pages) to serve as a reference for a category of OTC medications or

home monitoring/diagnostic products. The purpose is to serve as a resource to help a patient

select the best product for self-treatment. Choose from the list below (or as assigned by your

preceptor) and compare/contrast the individual products carried by the pharmacy you are

assigned to for your community IPPE rotation. The preceptor may help determine if all products

in the category should be included or only selected products, such as the top 5 best sellers.

Categories - OTC class or home diagnostic product:

Ophthalmic and contact lens

preparations

Otic preparations

Laxatives

Anti-diarrheals

Antacids (and other stomach

upset preparations)

Diet/weight control agents

Sleep aids

Topical antibacterials/

antiseptics and wound

irrigations

Yeast infection products

Contraceptive products

Sunburn prevention/ treatment

Diaper rash

Pediatric fever and pain relief

products

Home diagnostic products:

o pregnancy tests

o blood glucose

o drug tests

Your report should include the following information, at a minimum:

OTCs Home Monitoring/Diagnostic Products

Background information on the selected

topic/OTC class

Names of the products in that category

carried at the pharmacy

Active Ingredients (if applicable)

Other ingredients (if to be considered in OTC

selection/recommendation to a patient)

Dosing

Indications

Contraindications

Drug/drug interactions

Drug/disease interactions

Adverse reactions

Toxicity

Recommendations for specific patient

populations (e.g., pediatrics, geriatrics,

disease states, etc.)

Patient teaching considerations

References

Background information on the selected

topic/OTC class

Names of the products in that category

carried at the pharmacy

Mechanism of action

Criteria for product recommendation

Patient teaching considerations

References

Assignment VI- Community Requirement

SOAP Note / Patient Self-Medication Consultation Worksheet

Please utilize this form to assure that you collect all of the information from the patient that is

needed in order to appropriately assess and document your OTC consultation experience.

1. Describe the symptoms and the symptom time frame which led this patient to seek OTC

therapy:

2. What other disease states or conditions does the patient have? What other medications is the

patient taking? How did this information influence your decision?

3. Your assessment of the patient’s situation.

4. Your detailed recommendation. It needs to include 4 components: a) specific

recommendation for treatment (include dose, route, and frequency for drug therapy); b)

rationale for your recommendation; c) recommendation for specific monitoring for efficacy

and safety; and d) patient education including when to seek additional help.

Student Name: Date: __________

Preceptor Name: Date: __________

SOAP Note

Final SOAP note to be typed for includion in the student portfolio.

Using the data obtained from your Patient Self-Medication Consultation worksheet or your

interview with the patient, please write a SOAP note for each patient following the format

provided.

SOAP Notes Guide

Subjective

Information that the patient relates back to the health care practitioners regarding her/his conditions

Perceived by the patient and not evident to the health care provider (i.e. pain, nausea, fatigue,

dizziness)

Ideas and opinions of the patient – often the chief complaint

Objective

Quantifiable data the health care provider observes without bias

All information that can be reproduced or verified

Facts (i.e. laboratory tests, vital signs, diagnostic tests, medication profile)

Should NOT include anything the patient has told the provider

o However, may include information that supports the subjective information provided by the

patient, for example:

Subjective: “I’m depressed, I can’t stop crying.”

Objective: The patient is tearful today.

Assessment Usually includes diagnoses noted by the physician or nurse practitioner

o Pharmacists cannot diagnose a medical condition(s)

Should be a complete assessment

o Assessment of problem (with rationale)

o Assessment of present therapy (with rationale)

Pharmacy student SOAP notes should include their own evaluation of the subjective and objective

information

o For example:

Subjective: “I feel dizzy whenever I stand up.”

Objective: Patient has been on atenolol 50 mg daily for 2 years and BP had been well

controlled without dizziness until recently. Creatinine was 2 on admission. Baseline

creatinine was 1.1. BP 110/70, P 80 lying down. BP 80/40 with P 120 standing up.

Assessment: Patient’s dizziness is likely related to orthostatic hypotension secondary to

atenolol and its reduced clearance due the current change (decrease) in renal function.

Estimated creatinine clearance is 30 mL/min.

Plan

Strategy for treating/addressing the problem(s)

o Be specific! If making a recommendation to start a new medication, be sure to give drug

name, dose, route, and schedule.

Must include 4 components

o Specific recommendation for treatment (include dose, route, and frequency for drug therapy)

o Rationale for your recommendation

o Recommendation for specific monitoring (include safety and efficacy)

o Patient education

Discharge planning, immunizations, and counseling should be included.

Based on the issues defined in the Assessment portion, define a plan of action for each issue, including

non-pharmacologic and pharmacologic options. Be sure that this is something that is within a

pharmacist’s scope of practice (i.e. use “Recommend increase dose to…”, not “Increase dose to....”)

o i.e. for atenolol example above:

Plan: Recommend holding atenolol until orthostasis resolved and reinstitute atenolol at 25 mg

daily once BP is up. Monitor BP, orthostatic BP, and symptoms of orthostasis such as

lightheadedness/dizziness when getting up. Prior to discharge, will educate patient on the

change in dose if this is implemented. Will also educate regarding methods to manage

orthostasis including getting up slowly and dangling legs over the edge of the bed before

standing.

Completing Evaluations (Assessments)

1. STEPS TO BE COMPLETED IN ORDER

2. All forms to be completed and submitted via PharmAcademic unless otherwise indicated.

3. The student should review the PHARMACADEMIC process with their preceptor and the

evaluations should be entered online. The completed online assessment must be received by the

Director for Experiential Education no later than the last day of each rotation. It is the students’

responsibility to see that this is done.

MID-ROTATION:

Student:

1. Turn in all pertinent assignments to your preceptor for review prior to your Midpoint

evaluation.

2. Complete “IPPE- Student Mid-rotation Self-Assessment” (online in PharmAcademic). Print

and submit to your preceptor for discussion.

Preceptor:

1. During the second week of rotation complete the “IPPE -- Preceptor Midpoint Assessment of

Student” form and review the results with the student.

2. If the student is at risk for failure during the mid-rotation review, the preceptor should

contact the Director of Experiential Education. A plan of action should be developed between

the preceptor, the student and the Director of Experiential Education to improve the student’s

performance and chance of success. Please document concerns and pertinent plan using the

Midpoint Deficiency Notice (found in this manual following the Midpoint Assessment) and

submit to the Director of Experiential Education-Bradenton.

END of ROTATION:

Student:

1. Turn in all pertinent assignments to your preceptor for review at the Final Assessment as

outlined in the manual. The preceptor may ask to see ALL assignments from the full rotation,

so please have them ready for review.

2. Complete the “IPPE - Student Final Self-Assessment” (online in PharmAcademic). Print and

submit to your preceptor for discussion.

3. Complete the “Student Assessment of Site and Preceptor” (online in PharmAcademic).

Failure to submit this evaluation will result in a 5% deduction from the overall rotation

grade.

4. Your portfolio must be reviewed by your Advisor within 2 weeks of returning to campus

for the Fall term in order for you to receive credit for this work. This is worth 10% of

your grade for EACH rotation.

Preceptor:

1. During the fourth (last) week of rotation complete the “IPPE -- Preceptor Final Assessment of

Student” online in PharmAcademic and review the results with the student.

2. Please see the following pages for the questions that you will be asked to complete in

PharmAcademic when completing the online evaluation (assessment).

IPPE Midpoint Assessment of Student

Considering the student’s coursework to date (Introduction to Pharmacy, Pharmacy Law, Basic

Drug Information Skills, Communications, Calculations, Biochemistry, Anatomy and Physiology,

Microbiology, and Pharmaceutics), please evaluate the student in the following areas using

these criteria:

D = Deficient C = Competent E = Excellent

Student is not able to meet

expectations despite guidance

and/or multiple redirection

attempts on part of preceptor.

Student seems indifferent to

preceptor counseling.

Assignment quality is poor or

incomplete. Significant

revision is still needed.

Student is able to meet

expectations with guidance

from the preceptor in most

cases but some refinement may

be needed. Completes

assignments and follows

directions.

Student is open to feedback.

Assignments are of adequate

quality; may have required

moderate corrections but

overall outcome is sufficient.

Student consistently and

independently fulfills and

sometimes exceeds

expectations compared to

usual students.

Is proactive in approach to

various situations, to learning,

and in communicating. Is a

model student.

Assignments are of high

overall quality and required

minimal correction to complete

1) Knowledge Base

A. Order fulfillment/drug and pharmacy systems knowledge

Example competencies: Evaluation:_______

a. Completes basic order interpretation and dispensing of requested product

b. Displays basic knowledge of brand/generic and drug purpose

c. Performs pertinent calculations

d. Demonstrates error prevention process

B. Knowledge support skills

Example competencies: Evaluation: _______

a. Retrieves additional information when needed (e.g. from patient/caregiver, chart, package

insert, nurses, insurance company, pharmaceutical company, etc.)

b. Researches basic drug information questions

c. Interprets information from basic literature, manuals, or other references

2) Technical Skills


a. Acquires from stock and accurately prepares medications

b. Displays good technique (after training) in preparation of parenteral products

c. Able to navigate use of technology appropriately (dispensing systems, computers, etc)

d. Identifies/troubleshoots basic problems

e. Able to incorporate self into workflow of the pharmacy effectively

f. Files necessary paperwork, electronic data

3) Communication Skills

A. Verbal/non-verbal communication


a. Uses appropriate verbal (clear, concise) communication skills with preceptor/other staff

b. Displays appropriate non-verbal mannerisms during all interactions

c. Communicates with preceptor/staff when more guidance is needed

d. Interacts effectively with patients

e. Delivers live presentations effectively

B. Written communication


a. Uses appropriate written (legible, accurate, format, professional) communication skills in

assignments/other communications

b. Crafts appropriate SOAP note/care plan

4) Professionalism

A. Attitude


a. Accepts constructive feedback and responsibility. Recognizes own limitations.

b. Enthusiastic about learning/ self-motivated/ self-confident for level of experience/

participates in discussion and activities

c. Displays caring, non-judgmental attitude toward patients, caregivers, or health care

colleagues (including culture, religion, gender, or personal lifestyle)

d. Appears invested in well being of patients, success of colleagues/site in delivering patient

care.

e. Respect other's opinions/ consensus seeking

f. Remains focused and not distracted from duties/responsibilities

B. Professional Ethics


a. Arrives on time (and forms preceptor promptly otherwise), appropriate attire/appearance,

uses professional language, collegial

b. Adheres to laws, regulations, and site specific policies/procedures.

c. Conscientious in completing assigned tasks in a timely fashion

d. Maintains confidentiality (patient/proprietary)

5) Assignments

Has student completed the following required assignments to date (note, grades are recorded on

the final evaluation):

a. Site description Yes / No

b. Midpoint Reflection

c. Any additional preceptor-directed assignments

6) Preceptor's Comments regarding student performance to date:

7) Please indicate the number of days the student has been absent from this rotation to date:

0 1 2 3 4

8) How many of these absent days did the student make up?

NA 1 2 3 4

9) Is this student in danger of failing this rotation? If yes, please contact the Director of

Experiential Education, Dr. Laura Stevenson (941-782-5677) as soon as possible to discuss

a plan for student improvement.

Yes No

10) This evaluation was verbally discussed with the student.

Yes No

Midpoint Deficiency Notification

Please contact the Director of Experiential Education immediately by phone (941-782-5677) or

email ([email protected]) if there is a concern the student may fail the rotation. Please complete

and forward this notification to attention of Dr. Laura Stevenson by fax (941-782-5733) or as a PDF

via e-mail to document concerns and the action plan.

Attach additional pages if needed.

Student’s Name: __________________________________ Date: ________________

Rotation Site: ____________________________________

Preceptor’s Name: ________________________________

Description of deficiency:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Action Plan for Improvement:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Student’s Signature: __________________________________________

Preceptor’s Signature: _________________________________________


IPPE- Sample Student Self-Assessment

This assessment documents the progress and achievement of objectives for the IPPE rotation. An honest

self-assessment will help you focus your learning endeavors and development of professional skills. This

evaluation should be performed towards the end of the second week and at the end of the fourth

week of

the rotation and provided to your preceptor prior to your evaluation.

















directions.








sometimes exceeds


usual students.




model student.




1) Knowledge Base













2) Technical Skills





















4) Professionalism

A. Attitude








care.










5) Assignments (all listed here are due at Final)

a. Site description Evaluation: ________

b. Midpoint Reflection Evaluation: ________

c. Med Class Review (Comm.)/DI Question (Inst.) Evaluation: ________

d. SOAP Note (Comm.) or Medication History (Inst.) Evaluation: ________

e. Final Reflection Evaluation: ________

6) Midpoint- Comments regarding my performance to date

Final- Comments regarding my overall performance on this rotation:

7.) Midpoint only: My plans for improvement during the second half of rotation include:

IPPE Final Assessment of Student

Considering the student’s coursework to date (Introduction to Pharmacy, Pharmacy Law, Basic

Drug Information Skills, Communications, Calculations, Biochemistry, Anatomy and Physiology,

Microbiology, and Pharmaceutics), please evaluate the student in the following areas using

these criteria:

















directions.








sometimes exceeds


usual students.




model student.




1) Knowledge Base













2) Technical Skills





















4) Professionalism

A. Attitude








care.










5) Required Assignments

a. Site description Evaluation: ________

b. Midpoint Reflection Evaluation: ________

c. Med Class Review (Comm.)/DI Question (Inst.) Evaluation: ________

d. SOAP Note (Comm.) or Medication History (Inst.) Evaluation: ________

e. Final Reflection Evaluation: ________

6) Preceptor's Overall Comments regarding student performance on rotation:

7) Please indicate the number of days the student has been absent from the entire rotation:

0 1 2 3 4

8) How many of these absent days did the student make up?

NA 1 2 3 4

9) Did the student complete a minimum of 160 hrs during this rotation?

Yes No

10) Student contacted site a minimum of 4 weeks prior to the start of rotation, completed all

necessary pre-work, and reviewed manual with preceptor at the beginning of the rotation.

(Failure to follow policy will result in 5% deduction of grade.)

Yes No

11) LECOM calculates the grade based on the way you evaluated the student above. However,

based on your overall assessment of the student, what would you recommend for this

student’s overall grade?

A (Excellent; 89.5-100) B (Good; 79.5-89.4) C (Average; 69.5-79.4) F (Failure; 69.4 or less)

12) I completed and discussed a midpoint evaluation with the student.

Yes No

13) This evaluation was verbally discussed with the student at the end of the rotation.

Yes No

Student Assessment of Site and Preceptor

The student should complete this form at the end of the rotation and prior to receiving the final

grade and evaluation from the preceptor. Your preceptor will receive feedback in the future

regarding his/her performance.

The evaluation form appears as follows:

Evaluated: “Preceptor Name” Delivery Date: “Date/Time will be present”

Assessment: Student Evaluation of Preceptor/Site Due Date: “Date/Time will be present”

Evaluator: “Student Name”

Using the following key, complete each statement.

1 = Strongly Disagree

2 = Disagree

3 = Neutral

4 = Agree

5 = Strongly Agree

Failure to submit this evaluation will result in a deduction from the rotation grade.

Page 1 - Student Evaluation of Preceptor/Site

A. Student Evaluation of Preceptor/Site

Strongly Disagree Disagree Neutral Agree

Strongly Agree

1. The site provided a good opportunity to experience the rotation learning objectives.

2. The site provided an environment conducive to student learning.

3. I was made to feel welcome at the site.

4. I had the opportunity to interact with other health care professionals.

5. I had the opportunity to interact with diverse patient populations.

6. The preceptor provided timely feedback.

7. The preceptor provided helpful feedback.

8. The preceptor provided opportunities conducive to learning.

9. The preceptor served as a positive role model.

10. The preceptor is a highly competent pharmacy practitioner.

11. The preceptor demonstrated collegiality with all team members.

12. The preceptor was receptive to questions and other viewpoints.

13. The preceptor is a dedicated and enthusiastic teacher.

14. Would you recommend this preceptor for recognition as an outstanding preceptor? If yes, please explain.

Comments:

Yes

No

*15. What did the preceptor do that was most effective in supporting your learning needs?

*16. How could the learning experience be improved?

*17. My preceptor reviewed my performance at the rotation's midpoint.

Yes

No

*18. My preceptor reviewed my overall performance at the end of the rotation (or is scheduled to do so).

Yes

No

19. Other comments:

Submit

PharmAcademic User Information

General Instructions for using PharmAcademic


PharmAcademic is the rotation management software system used by the LECOM School of

Pharmacy to track all pharmacy rotations and associated information. Every preceptor and

student will be able to use the system, via the Internet, to check for rotation updates, maintain

addresses, record activities, and complete evaluation forms (if applicable).

The following pages are intended to provide basic instructions for use of the system.

PharmAcademic ID’s and passwords are intended for the recipient only. Please do not share your

ID or password with anyone. Unauthorized use is prohibited.

IMPORTANT: At this time, PharmAcademic supports Internet Explorer and

Mozilla FireFox. Please use one of these browsers when completing

assessments.

If you have questions, do not hesitate to contact us so we can provide assistance to you. Thank

you.

PharmAcademic: Login/Change Password

Steps for logging in to PharmAcademic:

1. Click on a link to PharmAcademic in an email message sent to you, or type

http://www.pharmacademic.com into your internet browser.

2. If your email address is not pre-populated, type your email address in the PharmAcademic

Email box.

3. Type in your password. If you are using an automatically-generated password (such as the

initial one you receive), copy and paste it from the email message so you do not need to

identify each of the characters.

Steps for changing your password in PharmAcademic:

http://www.pharmacademic.com/

1. Log in to PharmAcademic.

2. Type or copy and paste your current (old) password into the Current Password box.

3. Select a new password that meets the requirements described on the screen. It must be at

least 7 characters long, and contain one character that is both not a letter and not a number

(such as a punctuation mark).

4. Type in your new password two times in the boxes provided.

5. Click the Change Password button. Your new password is valid immediately.

PharmAcademic Instructions for Preceptors – Bradenton Campus

View Current Schedule:

1. Hover over the Experiential Training menu (in the bar on the far left), and click “Preceptor

Availability/Schedule”.

2. A screen will appear that shows options to view availability and schedule, rotations, and

evaluations. By default, the availability/schedule screen is displayed.

3. Select the appropriate match from the drop-down box. A match consists of a group of

students and the rotations that are scheduled for those students over a specified time frame.

Only those matches where you are a preceptor will be included in your drop-down box.

4. Your schedule should appear listing the students assigned to you.

Entering Availability for FUTURE Matches for LECOM SCHOOL OF

PHARMACY-BRADENTON CAMPUS

PLEASE NOTE:

Bradenton preceptors will be notified when this process is implemented

Availability is entered separately for the Bradenton and Erie campuses

You will need to follow the directions below for each match in which you are accepting

students (e.g. IPPE and APPE).

When it is time to indicate your availability, you will be notified by email. Log on to

PharmAcademic as before and choose “Preceptor/Availability” from the Experiential Training

menu. Choose the match where you need to indicate availability. You can indicate availability

per block, total number of students accepted and/or total number of blocks accepted for LECOM

SCHOOL OF PHARMACY-BRADENTON CAMPUS.

Per rotation per block availability: Enter your availability per rotation and per block, noting

the number of students you are willing to accept for each block, for each rotation. Blocks are the

actual rotation time periods defined for the match. You will want to put zeros for any blocks

where you cannot accept students. Please put non-zero availability for as many blocks as

possible in this section. You can limit the total number of blocks and/or students as described

below.

To change the specified availability for any line in this table, click the “edit” link on the far right.

The row you selected will become yellow. Type the number of students you will accept for that

block and that rotation in the box, and click “update”.

You may find the quick links just above the table to be helpful. They will set the availability for

all rotations and all blocks to a specified number. You can, of course, edit each of the rows

specifying your availability after clicking one of the quick links.

If you offer multiple rotations, you can choose whether to accept students in both rotations at the

same time, or whether you only accept students in one rotation at a time. In order to accept

students in both/all rotations, put non-zero availability for both/all rotations for each block. To

ensure that only one rotation is scheduled for each block, put non-zero availability for only one

rotation in each block.

Number of Students Accepted for this Match: Further limit the total number of students you

accept for the entire match presented on this screen by entering a number here.

Number of Blocks to Schedule for this Match: Further limit the total number of blocks for

which you will accept students for the entire match presented on this screen by entering a

number here.

Special Availability Requests for the Experiential Training Office: Enter any additional

comments you have for the Experiential Training Office.

Click the “Save” button at the bottom of the screen. If needed, repeat the process for a second

match by selecting the second match after saving the current one.

Helpful hints/notes:

All of the availability restrictions will be respected by the automatically-generated schedule.

However, the Experiential Training Office at the School/College of Pharmacy is able to

override any preferences you specify.

If you do not want students in different rotations (e.g. Internal Medicine and Cardiology) at

the same time, make your availability greater than zero for only one rotation for each block.

In order to provide maximum flexibility for scheduling students, please use the boxes at the

bottom of the screen to limit the total number of blocks or the total number of students you

will accept, instead of putting overly-restrictive requirements in the per rotation per block

availability at the top. Use the per-block availability to show only those blocks you cannot

accept students. For example, if you are willing to accept students for no more than 4 blocks

throughout the year, but there are no blocks where it is impossible for you to accept students,

put availability in all blocks on the top, but a maximum of four blocks at the bottom.

PharmAcademic will schedule students such that ALL of the requirements are met. Thus, no

more than the number of students per rotation per block listed at the top AND no more than

the maximum number of students AND no more than the maximum number of blocks will be

scheduled.

Completing a Student Evaluation: Preceptors

When an evaluation is due to be completed (including a SUCCESS evaluation), you will receive

an email notification similar to the one below. You can click on the included link to access the

evaluation. You will be redirected to PharmAcademic and be prompted to log in. This

evaluation contains the link to SUCCESS. You may log directly into SUCCESS to complete the

evaluation and bypass logging into PharmAcademic. This is set up as a convenience for you in

the situation you do not have the SUCCESS link easily available. Your login is the email

address to which the message was sent. If you don’t know your password, click the "Forgot

Password" link. Enter your e-mail address and PharmAcademic will reset your password and

send you a new one.

Alternately, any time you log in to PharmAcademic, your Home page lists any outstanding

assessments. The list will show the name of the assessment, the name of the person or the

course/rotation to be evaluated, and the date on which the assessment is due. Assessments will

drop off the list when complete or when the expiration date is past.

Select an assessment to begin.

Once the assessment is open, information at the top of each page lists the name of the evaluator,

the name of the person (or site/rotation) being evaluated, the name of the evaluation and the due

date.

Evaluations may have several sections, so upon completing a page, you may need to select the

Next button to go on to the next part of the assessment. When you are done, you may submit the

assessment by clicking the “Submit” button, or save it to review later by selecting the “Back to

Home” button.

Throughout the assessment, there may be required questions which are marked with an asterisk.

If you do not answer these required questions, you will be prompted to go back and complete

them before you can submit the evaluation.

You may receive email reminders if you do not complete an evaluation by the due date. These

are set up by the sender, and can be set to repeat if the evaluation remains unsubmitted.

Once completed, you may view Experiential Training evaluations in PharmAcademic. From the

Experiential Training menu, select the Preceptor Availability/Schedule screen, and select My

Evaluations. Select an appropriate search date range and the evaluations will be listed. Selecting

the View link opens the completed evaluation as a PDF document in a separate window. You

will need a PDF reader to view these evaluations.

Note: At this time, PharmAcademic supports Internet Explorer and Mozilla FireFox.

Please use one of these browsers when completing assessments.

Viewing Completed Evaluations: Preceptors

Completed evaluations of students can be viewed as PDF documents in PharmAcademic. From the menu on the left side of the screen, hover over the Experiential Training option and select “Preceptor Availability/Schedule.” Click on the My Evaluations link to see the screen shown below.

Preceptor evaluation viewer This screen is not match specific, so preceptors must enter a date range and search for evaluations with due dates within the specified range. Clicking on the View link on the left side of the grid will open the evaluation as a PDF in a separate window. Evaluations can be printed from the PDF reader window. Preceptors can see all evaluations which they have completed about students. Depending on the setting checked by the Experiential Training office for each match on the “Match Assessments, Grades and Contact Hours” screen, preceptors may also be able to view preceptor evaluations completed by students about them. Please note that this is not the screen where preceptors can find evaluations which need to be

submitted. Evaluations that are currently available to be completed are listed on the Home

screen. More information about completing evaluations can be found in the Completing an

Evaluation: Preceptors document available on the Help and Support screen.

PharmAcademic Instructions for Students

When an evaluation is due to be completed in PharmAcademic, you may receive an email

notification similar to the one below. You can click on the included link to access the

evaluation. You will be redirected to PharmAcademic and be prompted to log in before you can

begin the evaluation. Your login is the email address to which the message was sent. If you don’t

know your password, click the "Forgot Password" link. Enter your e-mail address and

PharmAcademic will reset your password and send you a new one.

Alternately, any time you log in to PharmAcademic, your Home page lists any outstanding

assessments. The list will show the name of the assessment, the name of the person or the

course/rotation to be evaluated, and the date on which the assessment is due. Assessments will

drop off the list when complete or when the expiration date is past.

Select an assessment to begin.

Subject PharmAcademic Student Assessment Notification: End of Rotation Assessment Form

From McCreadie Group Support

To [email protected]

Sent Thursday, September 02, 2010 11:51 AM

You have been assigned the following assessment. Please click on the link(s) below to complete the assessment. The assessment is also listed on your home screen when you log into PharmAcademic. Assessment: End of Rotation Assessment Form Type: Student Due Date: 2/28/2011 Subject: John Doe http://www.pharmacademic.com/pharmacademic/Assessments/Assessment.aspx?id=be If you don't know your password, please go to http://www.pharmacademic.com/pharmacademic/login.aspx and click the "Forgot Password" link. Enter the e-mail address that this message was sent to and PharmAcademic will reset your password and send you a new one.

Once the assessment is open, information at the top of each page lists the name of the evaluator,

the name of the person (or site/rotation) being evaluated, the name of the evaluation and the due

date.

Evaluations may have several sections, so upon completing a page, you may need to select the

Next button to go on to the next part of the assessment. When you are done, you may submit the

assessment by clicking the “Submit” button, or save it to review later by selecting the “Back to

Home” button.

Throughout the assessment, there may be required questions which are marked with an asterisk.

If you do not answer these required questions, you will be prompted to go back and complete

them before you can submit the evaluation.

You may receive email reminders if you do not complete an evaluation by the due date. These

are set up by the sender, and can be set to repeat if the evaluation remains unsubmitted.

Once completed, you may view Experiential Training evaluations by viewing your schedule in

PharmAcademic. From the Experiential Training menu, select the Student Ranking/Schedule

screen, and select Details next to a rotation. Evaluations will be listed, and those that are

complete have a View link. Selecting the View link opens the completed evaluation as a PDF

document in a separate window. You will need a PDF reader to view these evaluations. Any

incomplete evaluations which have not expired will have an active “Go” link which will redirect

you to the evaluation.

Completed evaluations are also available in PharmPortfolio™. From the education record, select

the “More…” link next to the rotation, then select the Assessments tab. Completed evaluations

will be displayed with a View link which opens the evaluation as a PDF document in a separate

window as above.

Note: At this time, PharmAcademic supports Internet Explorer and Mozilla

FireFox. Please use one of these browsers when completing assessments.

Viewing Completed Evaluations: Students

1. Log in to PharmAcademic

2. Select “Experiential Training” on the left and then select “Student Ranking/Schedules” in

the menu that pops up.

3. Select the correct match.

4. You should now see your rotation schedule.

5. Find the rotation for the evaluation you would like to view and click on “Details”

6. The rotation will expand to show the details. At the bottom, there will be section labeled

“My Evaluations”. This will show all completed evaluations for that rotation whether

filled out by you or the preceptor.

7. Click on “View” to the right of the evaluation you want to look at. If the evaluation you

are looking for is not there or will not open, then it has not been submitted. You will not

be able to view evaluations unless they have been completed by the evaluator.

Site-Specific Requirements

Fulfilling Site-Specific Requirements

II. Background Checks, Drug Screens, MVRs, Child Abuse

Clearance, Fingerprinting

Students must check with rotation sites at least 4-6 weeks in advance to discover what is

required by the site. Exception: VA sites must be contacted at least 6 weeks in advance of

the rotation.

LECOM School of Pharmacy has contracted with Certiphi and FieldPrint to provide students

with a convenient and economical means of obtaining background checks, drug screens or finger

printing when possible (exception: PA Fingerprinting). Directions for use are on the following

pages. A link is provided in this section and is also available on the main page of the LECOM

portal.

CERTIPHI INSTRUCTIONS

LECOM - Bradenton, FL Campus

A summary of the background check and drug screen instructions is included below. Detailed

instructions follow this summary.

Instructions Packages

1. Click the link below or paste it into your browser: http://www.applicationstation.com 2. Enter the Code:

Background Check: LECOMSTUDENT in the Application Station Code field. Drug Screen: LECOMSCREEN in the Application Station Code field.

3. Click the "SIGN UP NOW" button to create an account. 4. Follow the instructions on the Application Station web site. If you have questions about the screening requirement, please contact Lake Erie College of Osteopathic Medicine School of Pharmacy. If you have technical issues visiting the Application Station site, please contact Application Station Support at: 888-291-1369 x2006.

Background Check: SSN Validation and Verification Florida Statewide Criminal Search (FDLE) County Criminal Search – for all counties

outside of Florida Federal Criminal Records Search – for all

U.S. Districts of residence for the past seven years

National Sexual Offender Registry Search OIG/GSA EPLS SanctionsBase – includes state excluded

parties list and OFAC Employment Verification – 2 employers NOTE: Does NOT include driving record

Price: $87.00

Drug Screen: 10 panel

Price: $29.00

http://www.applicationstation.com/

Report Delivery Manager

NOTE: LECOM suggests you check with your rotation site if they need the results

reported directly to them. Some of these checks can take many weeks to complete;

therefore it is necessary to contact rotation sites at least 4-6 weeks before the start of

the rotation.

Report Delivery Manager (RDM) allows students to distribute an electronic copy of your

background check and drug screen results to a third party. RDM can be found in Application

Station: Student Edition. Please see the document titled Student Report Delivery Manager for

step-by-step instructions. Reports are available to students for 12 months. If reports are needed

beyond 12 months, students must print a copy to be distributed as needed.

If you encounter issues with the Application Station: Student Edition or have questions regarding

the site, please contact Certiphi’s Help Desk at 888-260-1370, ext 2006 or

[email protected]. If you are still running into problems acquiring your records, you may

contact the LECOM Office of Security at 941-782-5908 during daytime business hours for

assistance in acquiring your reports.

What to do if you need a Background Investigation?

The process below is for the first background check that you have ever ordered from

Certiphi

The cost for the initial background check is $87.00.

Locate the email from [email protected] titled “Application Station – Student

Edition”. The email will include step-by-step instructions for accessing Application Station:

Student Edition to authorize and pay for a background investigation.

If you are unable to locate the email, instructions are as follows.

Lake Erie College of Osteopathic Medicine School of Pharmacy has asked that you use the

Application Station - Student Edition to complete necessary additional screening services

through Certiphi Screening, Inc. To do so, please follow the instructions below:

1. Click the link below or paste it into your browser: http://www.applicationstation.com

2. Enter the Code: LECOMSTUDENT in the Application Station Code field.

3. Click the "SIGN UP NOW" button to create an account.

4. Follow the instructions on the Application Station web site.

Note – please store the username and password created for Application Station in a secure

location. This information is needed to enter Application Station in the future which includes

obtaining a copy of your background investigation.



[email protected].





Background Investigations are completed, on average, within 3 to 5 business days. Once

completed, you will receive an email from Certiphi Screening. Follow the link in the email to

access Application Station: Student Edition to view the report. Application Station includes

instructions for disputing information included in the background check should you feel anything

is incorrect.

The initial background investigation consists of the search components listed below. All records

are searched by primary name and all AKAs, a student’s primary address, and all addresses lived

within the past seven years.

SSN Validation and Verification

Florida Statewide Criminal Search (FDLE)

County Criminal Search – for all counties outside of Florida

Federal Criminal Records Search – for all U.S. Districts of residence for the past seven

years

National Sexual Offender Registry Search

OIG/GSA EPLS

SanctionsBase – includes state excluded parties list and OFAC

Employment Verification – 2 employers

NOTE: Does NOT include driving record

What to do if you need an updated Background Investigation?

This applies if you have ordered a background investigation from Certiphi previously

while a LECOM student.

The cost for an updated background check is $53.00






through Certiphi Screening, Inc.

To do so, please follow the instructions below:


2. Enter the Code: LECOM-RECHECKFL in the Application Station Code field.




location. This information is needed to enter Application Station in the future which includes

obtaining a copy of your background investigation.





[email protected].

Background Investigations are completed, on average, within 3 to 5 business days. Once

completed, you will receive an email from Certiphi Screening. Follow the link in the email to

access Application Station: Student Edition to view the report. Application Station includes

instructions for disputing information included in the background check should you feel anything

is incorrect.

The search components included in an updated background investigation are listed below. All

records are searched by primary name and all AKAs, as well as a Pennsylvania Statewide

Criminal Search (PATCH), a student’s primary address, and all addresses lived within the past

three years.

Social Security Number Validation

Social Security Number Verification

Pennsylvania Statewide Records Search (PATCH)

County Criminal Records Search – any county lived outside of Pennsylvania

Federal Criminal Records Search – all U.S. District Courts of residence

National Sexual Offender Registry Search

Employment Verification – two most recent employers

SanctionsBase Search

OIG/EPLS Search

What to do if you need a 10-Panel Drug Screen?

The cost of a drug screen is $29.00 for an in-network facility. Additional fees may

apply if you need to use an out-of-network facility.

Locate the email from [email protected] title ““Application Station – Student

Edition”. The email will include step-by-step instructions (also listed immediately below) for

accessing Application Station Student: Edition to pay for the drug screen as well as locate a

collection site. If none of the collection sites listed are convenient (within 30 minute drive),

please contact Certiphi’s Occupational Health Screening Department for assistance with locating

an alternate location; phone number 800-803-7859.



through Certiphi Screening, Inc.



2. Enter the Code: LECOMSCREEN in the Application Station Code field.







location. This information is needed to obtain a copy of your drug screen.

After you have paid for the drug screen, please follow these instructions:

Before the Collection 1. Please log on to www.applicationstation.com before going for your drug screen

collection.

2. Provide the LabCorp technician account number at the time of collection (provided when

you order the drug screen). The LabCorp technician will create an electronic COC (chain

of custody) for your drug screen collection.

3. You are required to have valid photo identification with you. (Examples: driver’s license

or other photo identification card)

After the Collection 1. Obtain the donor copy of the chain of custody form prior to leaving the collection facility.

2. Within one hour of completion of all testing, call Certiphi Screening (a division of

Vertical Screen) at 800-803-7859. Have your copy of the chain of custody form

available.

3. If drug screen is performed before logging on to www.applicationstation.com it can cause

a delay with receiving your drug screen results.

If the initial drug screen is reported as positive/non-negative, you will receive a call from

Certiphi’s Medical Review Officer (MRO). The MRO will obtain medical proof as to why you

test positive. If you are on any form of prescription medicine, it is wise to obtain proof from

your physician to be provided to the MRO when contacted. This will speed up the process of

reporting drug test results.

You will receive an email from Certiphi Screening once drug test results are available. Follow

the link in the email to access Application Station: Student Edition to view the report.

All drug screens conducted for LECOM are 10-panel and tests for:

Amphetamines

Cocaine Metabolites

Marijuana Metabolites

Opiates

Phencyclidine

Barbiturates

Benzodiazepines

Methadone

Propoxyphene

Methaqualone





[email protected].

What to do if you need a Motor Vehicle Report (driving history)

The cost of a motor vehicle report is $3.00 plus applicable state processing fees

($13.00 total for FL).




If you are unable to locate the email, instructions are as follows.


Application Station - Student Edition to complete necessary screening services through Certiphi

Screening, Inc.



2. Enter the Code: LECOMFL-MVR in the Application Station Code field.



FIELDPRINT INSTRUCTIONS

LECOM - Bradenton, FL Campus

What to do if you need a fingerprint for a Florida rotation site (an AHCA fingerprint)?

The cost for an AHCA Fingerprint - $54.25.

1) Visit www.FieldprintFlorida.com.

2) Click the “Schedule an Appointment” button, which links to our scheduling website.

3) Follow the wizard instructions to log into the site. Provide your Fieldprint Code of

FPLakeErieOsteo1. At that point, you are ready to schedule your fingerprint appointment.

4) At the end of the process, print the Confirmation Page. Take the Confirmation Page with you

to your fingerprint appointment, along with two forms of identification. At least one form of ID

must be a valid, government issued Photo ID, such as a driver’s license.




http://www.fieldprintflorida.com/

Once fingerprints have been collected, results will be electronically submitted to AHCA. AHCA

will not return fingerprint report results to the student or school. However, the clinical site will

access results directly from AHCA. The site will need your name, SSN, and date of birth.

What to do if you need fingerprinting for other states?:

If you are located in PA and need fingerprinting:

1 Contact at www.pa.cogentid.com

2. Select Department of Public Welfare (DPW)

3 Select Register Online from the Registration Column

4. Fill in YELLOW areas

a. Reason Fingerprinted: choose "Employment with a significant likelihood of regular

contact with children" b. SSN should be filled in to assure a better match

c. Driver's License No should also be included

5. Select Next

6. Verify your information

a. If correct select Next

b. If not correct select Go Back and repeat steps 4 to 6

7. Fill in Payment information

8. Select Pay

9. Go to location to have fingerprints taken. Locations that can take fingerprints are available on

the Cogent web site.

If you are NOT located in FL or PA and need fingerprinting:

Request specific instructions from your preceptor or appropriate person at the rotation site.

Contact the Administrative Assistant for Experiential Education on campus (941-782-5676) and

provide information about the request and the process.

OTHER SCREENING INSTRUCTIONS

What to do if you need a Pennsylvania Child Abuse Clearance

The cost of a Pennsylvania Child Abuse Clearance - $10.00 state fee

Instructions for completing the Pennsylvania Child Abuse Clearance search and a pdf copy of the

state forms can be found on the Release and Disclosure page of Application Station: Student

Edition. The completed form must be submitted to the PA Department of Children Services

along with a $10.00 money order or cashier’s check. Instructions for this process are provided

when you open the link for the child abuse clearance form. Results of the child abuse search will

be returned to the student and must be kept for future reference.

http://www.pa.cogentid.com/

Note – do not return the completed PA Child Abuse form to Certiphi Screening. The form is to

be submitted directly to the PA Department of Children Services.

Note – please store the username and password created for Application Station

in a secure location. This information is needed to enter Application Station in

the future which includes obtaining a copy of your background investigation.



[email protected].

Motor Vehicle Reports are completed, on average, within 1 to 2 business days. Once completed,

you will receive an email from Certiphi Screening. Follow the link in the email to access

Application Station: Student Edition to view the report. Application Station includes instructions

for disputing information included in the background check should you feel anything is incorrect.


Resources

Important Contact and Resource Information

LECOM School of Pharmacy 941-756-0690

5000 Lakewood Ranch Blvd

Bradenton, FL 34211

Office of Experiential Education [email protected]

Julie Wilkinson, Pharm.D, MS, BCPS 941-782-5678

Associate Dean of Clinical Education [email protected]

Associate Professor

Laura Stevenson, Pharm.D, M.S., 941-782-5677

Director of Experiential Education [email protected]

Associate Professor

Deborah Atkinson, CPhT 941-782-5676

Administrative Assistant to the [email protected]

Director of Experiential Education

Resources:

LECOM Website: http://lecom.edu/

LECOM Learning Portal: https://portal.lecom.edu/ics/

LECOM Web Page for Preceptors: http://lecom.edu/pharm_mentor.php

Rotation Manuals

PharmAcademic: https://www.pharmacademic.com

The Pharmacist’s Letter Preceptor Training and Resource Network:

http://pharmacistsletter.therapeuticresearch.com/ptrn/default.aspx?cs=&s=PL

Certiphi (Background Checks / Drug Screens): http://www.applicationstation.com

FieldPrint (Fingerprinting for FL rotation sites): http://www.fieldprintflorida.com/

Florida Board of Pharmacy: 850 – 245-4292

http://www.doh.state.fl.us/mqa/pharmacy

National Association of Boards of Pharmacy: http://www.napb.net/




http://lecom.edu/

https://portal.lecom.edu/ics/

http://lecom.edu/pharm_mentor.php

https://www.pharmacademic.com/

http://pharmacistsletter.therapeuticresearch.com/ptrn/default.aspx?cs=&s=PL


http://www.fieldprintflorida.com/

http://www.doh.state.fl.us/mqa/pharmacy

http://www.napb.net/

REQUIRED DOCUMENTATION DEADLINE

Records Release Form Completed 1st

Week of School Florida Pharmacy Intern License End of P1 Fall Semester (deadline will be posted) (other states if necessary)

Medical

2-step PPD skin test, then

annual PPD skin test (Chest X-Ray if positive to skin test)

Prior to orientation and in May of subsequent years

(Exception: P2 students requiring chest x-ray do not need

to complete)

Physical Exam Prior to orientation and in subsequent years (as directed) Other - Site Specific Site Specific Immunizations completed and furnished to LECOM Prior to orientation

Proof of adequate titers for: Matriculation Deadline

(Note: Rotation may not be started until complete) Varicella Rubella Mumps Rubeola Hepatitis B

Background Check to LECOM Prior to orientation and subsequent years (as directed) LECOM Certificate of Self-Insurance Site to request from Director of Experiential Education (if

needed)

CV sent to your rotation site (Includes – Your contact information, phone, email, work history, etc.)

Send to site 4 – 6 weeks prior to the start of each rotation

Review Manual with Preceptor 1

st day of each rotation

Rotation Assessments returned to LECOM Students: PRIOR to receiving final evaluation

Preceptors: Midpoint and end of rotation

Report personal intern hours to State Board of Pharmacy

other than Florida As required by the State you wish to practice and/or have

your intern license

LECOM BRADENTON SCHOOL OF PHARMACY EXPERIENTIAL CHECKLIST (Maintain this form in your rotation binder)

NOTE: PLEASE KEEP A COPY OF ALL MEDICAL AND LEGAL DOCUMENTS IN YOUR ROTATION BINDER

Student – Site Contact Form


Student Name________________ ______________________ Class of____________

Once rotations have been assigned it is the responsibility of the student to contact PRECEPTORS / rotation sites

APPROXIMATELY 6-8 weeks prior to start of rotation. Ask about specific requirements such as HIPAA training, immunizations

(Human Resources), OSHA, CPR, liability insurance proof etc.

Date of

Contact

Type of

Rotation

Rotation

Block

Site Name Contact Person Special Requirements

This form to be maintained in rotation binder and made available to LECOM faculty upon request.

LECOM SCHOOL OF PHARMACY – BRADENTON CAMPUS 5000 Lakewood Ranch Boulevard Bradenton, FL 34211

941.756.0690 fax 941.782.5733

[email protected]

Experiential Education Absence Request/Report Form

Except for an unplanned absence, this form MUST be submitted ten (10) business days prior to your request. Students who miss more than three (3) days per rotation for any reason may fail the rotation. Any absence NOT documented on this form will result in deduction of your rotation grade – 10% for planned and 5% for unplanned absences.

PRECEPTOR USE ONLY Please indicate how the time off for this request will be made up

Time DOES NOT need to be made up. (Note: Up to One (1) day per rotation, per preceptor discretion) Time DOES need to be made up. (Make up Dates and Times below)

Date Start Time End Time Total Hours

Date Start Time End Time Total Hours

Name: Date:

Rotation Type: IPPE APPE Dates of Rotation:

Name of Site:

Address:

Preceptor Name: Phone:

Email:

Requested Dates: Number of Days:

Total number of days absent for this rotation (to date):

Reason for Request (be specific):

Approved

Preceptor Signature Date Not Approved Approved (Excused)

Laura L. Stevenson, PharmD, MS Date Not Approved (Unexcused)

BOTH SIGNATURES ARE REQUIRED TO BE COMPLETE Date of Student Notification (via email)
